POSITIVE BEHAVIOR SUPPORT: CURRENT ISSUES AND FUTURE DIRECTIONS

1. POSITIVE BEHAVIOR SUPPORT: CURRENT ISSUES ANDFUTURE DIRECTIONS Linda Bambara and Lee Kern

2. THE PAST… Exclusion

3. Camarillo State Hospital, 1980s

5. Children’s Unit

8. THE PAST… Punishment

9. Types of Punishment Used With People With Disabilities • Time out (exclusion/seclusion) • Electric shock • Ammonia • Spanking • Water mist • School suspension/expulsion • Police intervention • Lemon glycerin • Seclusion time out • Overcorrection • Restraint

10. PUNISHMENT What Does the Research Say?

11. Comprehensive Literature Review:Research On Punishment(Guess, Helmstetter, Turnbull, And Knowlton 1987) Outcomes of punishment procedures (1965-1984) 16 journals 38 articles identified; 49 experiments 117 participants

12. Guess et al. (1987) Efficiency of Punishment (mean hours) • 176 toileting • 67 inappropriate oral behavior • 15 aggression/disruption • 9 self-injury • 4 stereotypy

13. Guess et al. (1987) Maintenance Reported for 16% of participants(includes anecdotal) Assessed for 12 months or less for71% of participants Effects maintained for 71%

14. Guess et al. (1987) Side effects • Reported in 45% of studies • 41% showed negative side effects • Emotional responses, escape or avoidance, negative modeling counteraggression

15. Guess et al. (1987) Design acceptability • 52% of studies contained one ormore design flaws

16. Guess et al. (1987) Demographics: Population 79% individuals with severe orprofound disabilities

17. Guess et al. (1987) Demographics: Setting • 78% institutions • 6% public schools

18. Guess et al. (1987) • Extensive implementation required (mean hours) How effective is punishment? • Aversive side effects reported in half of studies • Weak experimental design limits conclusions • Almost no information about long-term maintenance • More commonly used in restrictive settings

19. Events that Challenged Treatment of People With Disabilities Legal Challenges Wyatt v. Stickney (1972) Knecht v. Gillman (1973) Mackey v. Procunier (197e)

20. Other Variables • Deinstitutionalization • Inclusion • Focus on strengths • Self-determination

21. Where are we now?

22. Features Of PBS • Focus on role of environment • Interventions derived from assessment of behavior • Carr (1977) study • Provided evidence for communicative function for challenging behavior • Iwata et al. (1982) • Developed methodology for identifying behavioral function • Plans are individualized

23. Features Of PBS • Supports are preventive and instructive • Teaming is important • Interventions are respectful • Concern with long-term effectivenessof interventions

24. Features Of PBS • Openness to diverse theoretical perspectives • Flexibility with respect to experimental rigorand control • Social validity

25. Journal of Positive Behavior Interventions • Launched in 1999 • Purpose (Horner & Koegel, 2008) • Document outcomes of PBS strategies • Encourage dialogue among research and practitioners topromote PBS in natural settings

26. Review Of Intervention ResearchO’dell, S., Villardo, B., Kern, L., Kokina, A., Ash, A., Seymour, K., Castrantas, L., Kollar, R., Wagner, A.,Bartholomew, A., & Thomas, L.

27. PBS Research: Age Percentage

28. PBS Research: Disability Type Percentage

29. PBS: Setting Percentage

30. Prevention • Studies that… • Included antecedent interventions • Included skill building • 96% of the studies included antecedent strategies or skill instruction to prevent problem behavior

31. PBS Research: Intervention Type Percentage

32. Systems Change • Systems change was coded if efforts were sought to sustain the intervention • Administrative or family support • Funds for sustainability across time • Establishing a data information system

33. Systems Change • 37% of studies implemented systems change methods • Among studies including systems change,86% occurred in multiple settings

34. PBS Research: Intervention Duration Percentage

35. Stakeholder Participation • Relevant Stakeholder: relevant personal or professional interest in the intervention outcome • Ex. Participant, parent, friend, teacher, employer,or roommate • Participation: Contributed to intervention development and/or planning before any data collection took place • Ex. Helping to determine whether the intervention targets are relevant, selecting outcomes likely to improve quality of life

36. PBS Research: Stakeholder Participation Percentage

37. Social Validity Percentage

38. What should an individualized PBS plan look like?

40. Summary: Current Status Of PBS • Effectiveness demonstrated in numerous studies, including meta-analyses • Successful SWPBS outcomes in over 16,000 schools nationwide • Recent parent books and parent education classes on PBS have emerged • PBS has been endorsed in legislation (IDEA) • Numerous PBS grants and centers funded through Department of Education

41. Summary: Current Status Of PBS Strengths • High rate of stakeholder involvement, particularly in the area of intervention planning • Antecedent interventions and skill instruction are components of almost every intervention study

42. Summary: Current Status Of PBSAreas for Improvement • Application across disability categories, age groups, and settings • Implementation by natural change agents • Assessment of social validity • Systems change • Duration of intervention evaluation • Quality of life outcomes

43. CHALLENGES TO IMPLEMENTATION Stakeholder’s Perspectives

44. Informants • Qualitative Interviews with 4 stakeholder groups • 25 participants (5 states) • Teachers, administrators, parents, behavior specialists • Barriers/enablers to school implementation • National-level Survey • 293 school professionals (5 states) • PBS team members and team leaders • Barriers/enablers to school implementation • Qualitative Interview: Focus on Team Facilitators • 19 team facilitators (6 states) • Belief/emotional barriers? Solutions for support?

45. Barriers

46. Conflicting Beliefs and Practices • Exclusion: “Kids with challenging behaviors are better served elsewhere” • Beyond our control: “Nothing we can do for this kid” • Individualized interventions are “Unfair” • Must use strong consequences • Prevention means being “too soft” • Effective means “quick fix”

47. Foundational SWPBS Practices Inclusion Practices/ Values Administrative Support Shared Beliefs Unsupportive School Context Lack of:

48. LACK OF TIME TO MEET AND PLAN

49. PBS is Too Time Consuming Issue of fit?

50. Beyond Control External Factors Reactive Proactive Quick Fix Process I can’t do this I can! Inadequate Training and Long-term Supports • Technical Expertise • On-going supports • Skill development • New ways of thinking